Annex 12

SK of Barangay, City/Municipality, Province

CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS

Pursuant of COA Circular No. 2017-001 dated June 19, 2017

Name

Particulars Amount

TOTAL
Purpose

I hereby certify that the above expenses are incurred as they are necessary for the above cited purpose,
that above goods and services were acquired from parties not issuing receipts. And that I am fully aware
that willful falsification of statements is punishable by law.

Certified Correct by: Noted by:

Signature

Printed
Name

SK Official SK Chairperson
Date Date

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 Annex 12

CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS

(CENRR)

INSTRUCTIONS

A. This form shall be used to support expenses amounting to Three hundred pesos (P300) or
less which need not be issued official receipts/invoice. It shall be accomplished as follows:

1. SK of Barangay/City/Municipality, Province – name of the barangay SK,

City/Municipality and Province of the barangay
2. Name – the name of the SK official who paid the expenses
3. Particulars – details of payments
4. Amount – the amount of payment made
5. Total – total payments made
6. Purpose – the purpose for which the payment/s was/were made
7. Certified Correct by: – signature over printed name of the SK official who paid the
expenses and the date of signing
8. Noted by: – signature over printed name of the SK Chairperson and the date of
signing.

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